Of people who contemplate suicide, up to 90 percent have a mental illness

–Often undiagnosed:

10th leading cause of death in the U.S.

Suicide is one of the leading causes of death in the world

It has been estimated that 1 million people who die by it each year, with more than 36,000 suicides per year in the U.S. alone

Many more (600,000 in the U.S.) make unsuccessful attempts – “parasuicides”

It is difficult to obtain accurate figures on suicide rates, and many investigators believe that estimates are often low

Many “accidents” may be intentional deaths

Since suicide is frowned upon in our society, relatives and friends often refuse to acknowledge that loved ones have taken their own lives

Suicide is not officially classified as a mental disorder in the DSM-5 although framers have proposed that a category called suicidal behavior disorder be studied for future inclusion

People would qualify for a diagnosis if they have tried to kill themselves within the last two years

What are some patterns and statistics of suicide? 6 (women, men, guns, social support, divorced)

1. women have 3X higher attempt rates
2. men have 3X higher completion rates
3. guns used in 2/3 of male
4. someone with firearms in house: 3x more likely to die by suicide, 2x more likely to be a victim of homicide
5. divorced ppl have higher suicide rates
6. related to social support and marital status

What is Suicide:

Shneidman defines suicide as an intentioned death – a self-inflicted death in which one makes an intentional, direct, and conscious effort to end one’s life

He characterizes four kinds of suicide seekers…

Death seekers – clearly intend to end their lives

Death initiators – intend to end their lives because they believe that the process of death is already underway

Death ignorers – do not believe that their self-inflicted death will mean the end of their existence

Death darers – have ambivalent feelings about death and show this in the act itself

When individuals play indirect, hidden, partial, or unconscious roles in their own deaths, Shneidman classifies them in a category called “subintentional death” In recent years, another behavioral pattern, self-injury or self-mutilation, has been added to this list

The DSM-5 framers proposed that a category called non-suicidal self injury be studies for possible inclusion

People would quality for this diagnosis if they intentionally injure themselves on five or more occasions over a one-year period – without the conscious intent of killing themselves

How Suicide is Studied:

Suicide researchers face a major obstacle: their subjects are no longer alive

Researchers use two different strategies to try to overcome this obstacle (with partial success):

Retrospective analysis – a kind of psychological autopsy

Studying people who survive their suicide attempts

Researchers have gathered statistics regarding the social contexts in which suicides take place. Suicide rates vary from country to country, with religious devoutness (not simply affiliation) helping to explain some of the difference

The suicide rates of men and women also differ:

Women have a higher attempt rate (3x men)

Men have a higher completion rate (4x women)

Why? Different methods have differing lethality

Men tend to use more violent methods (shooting, stabbing, or hanging) than women (drug overdose)

Guns are used in nearly two-thirds of male suicides in the U.S., compared to 40% of female suicides

Suicide is also related to social environment and marital status

One study found that half of the subjects who had committed suicide were found to have no close friends

Divorced people have a higher suicide rate than married or cohabiting individuals

In the U.S., suicide also seems to vary according to race

The suicide rate of white Americans is almost twice as high as that of African Americans, Hispanic Americans, and Asian Americans

A major exception to this pattern is the very high suicide rate of American Indians, which overall is 1.5 times the national average

Triggers:

Suicidal acts may be connected to recent events or current conditions in a person’s life

Although such factors may not be the basic motivation for the suicide, they can precipitate it

Common triggers include stressful events, mood and thought changes, alcohol and other drug use, mental disorders, and modeling

Stressful Events and Situations:

Researchers have counted more stressful events in the lives of suicide attempters than in the lives nonattempters

One stressor that has been consistently linked to suicide is combat stress

Both immediate and long-term stresses can be risk factors for suicide

Immediate stresses can include the loss of a loved one, the loss of a job, or natural disaster

Long-term stressors can include:

Social isolation – individuals without social support are particularly vulnerable

Serious illness – especially those which cause great pain or severe disability

Abusive environments – from which there is little or no hope of escape

The “four-letter word” in suicide is “only,” as in “suicide was the only thing I could do”

Alcohol and Drug Use:

Studies indicate that as many as 70% of the people who attempt suicide drink alcohol just before the act

Autopsies reveal that about one-fourth of these people are legally intoxicated

Research shows the use of other kinds of drugs may have similar ties to suicide, particularly in teens and young adults

Mental Disorders:

Suicide is often linked to depression, however, 1/2 of all suicides have no mental disorder component or result from other mental disorders

Attempting suicide does not necessarily indicate the presence of a psychological disorder

Nevertheless, the majority of all suicide attempters do display such a disorder

Those with severe depression, chronic alcoholism, and/or schizophrenia are at greatest risk

Modeling: The Contagion of Suicide

It is not unusual for people, particularly teenagers, to try to commit suicide after observing or reading about someone who has done so..

One suicidal act appears to serve as a model for another

Suicides by family members and friends, celebrities, other highly publicized suicides, and ones by co-workers are particularly common triggers

Suicides with bizarre or unusual aspects often receive intense coverage by the news media, possibly leading to similar suicides

Even media programs clearly intended to educate and help viewers may have the paradoxical effect of spurring imitators

Some clinicians argue that more responsible reporting and postvention programs could reduce this effect

What Are the Underlying Causes of Suicide?

Most people faced with difficult situations never try to kill themselves

In an effort to explain suicide-proneness, theorists have proposed more fundamental explanations for self-destructive actions

Leading theories come from the psychodynamic, sociocultural, and biological perspectives

These hypotheses have received limited research support and fail to address the full range of suicidal acts

Underlying Causes of Suicide: The Psychodynamic View

Theorists believe that suicide results from depression and from anger at others that is redirected toward oneself

Additionally, Freud proposed that humans have a basic death instinct (“Thanatos”) that operates in opposition to the life instinct

While most people learn to direct their death instinct toward others, suicidal people direct it toward themselves

Underlying Causes of Suicide: Durkheim’s Sociocultural View

Durkheim argued that the probability of suicide is determined by how attached a person is to such social groups as the family, religious institutions, and community

The more thoroughly a person belongs, the lower the risk of suicide

Based on this premise, he developed several categories of suicide, including egoistic, altruistic, and anomic suicide…

Egoistic suicides are committed by people over whom society has little or no control

Altruistic suicides are committed by people who are so well integrated into their society that they intentionally sacrifice their lives for its well-being

Anomic suicides are those committed by people whose social environment fails to provide stable structures that support and give meaning to life

A major change in an individual’s immediate surroundings can also lead to this type of suicide

Despite the influence of Durkheim’s theory, it cannot by itself explain why some people who experience particular societal pressures commit suicide while the majority do not

Underlying Causes of Suicide: The Biological View

Family pedigree and twin studies support the position that biological factors contribute to suicidal behavior

For example, there are higher rates of suicide among the parents and close relatives of those who commit suicide than among nonsuicidal people

As always with this type of research, however, nonbiological factors must also be considered

In the past three decades, laboratory research has offered more direct support for a biological model of suicide

Serotonin levels have been found to be low in people who commit suicide

There is a known link between low serotonin and depression

There is evidence, though, of low serotonin activity among suicidal subjects with no history of depression

One possibility is that low serotonin activity may contribute to aggressive and impulsive behaviors

Is Suicide Linked to Age?

The likelihood of committing suicide increases with age, although people of all ages may try to kill themselves

Although the general findings about suicide hold true across age groups, three age groups (children, adolescents, and the elderly) have been the focus of much study because of the unique issues that face them

Children

Suicide is infrequent among children

Rates have been increasing over the past several decades

More than 6% of all deaths among children between the ages of 10 and 14 are caused by suicide

Boys outnumber girls by as much as 5:1

Suicide attempts by the very young generally are preceded by such behavioral patterns as running away, accident-proneness, temper tantrums, self-criticism, social withdrawal, dark fantasies, and marked personality changes

Despite common misperceptions, many child suicides appear to be based on a clear understanding of death and on a clear wish to die

Adolescents

Suicidal actions become much more common after the age of 14 than at any earlier age

About 1500 teens commit suicide in the U.S. each year

As many as 10% make suicide attempts and 1 in 6 may think about suicide each year

About half of teen suicides have been tied to clinical depression, low self-esteem, and feelings of hopelessness

Anger, impulsiveness, poor problem-solving skills, substance use, and stress also play a role

Some theorists believe that the period of adolescence itself produces a stressful climate in which suicidal actions are more likely

Far more teens attempt suicide than succeed

Ratio may be as high as 200:1

Several explanations, most pointing to societal factors, have been proposed for the high rate of attempts among teenagers

Teen suicide rates vary by ethnicity in the U.S.

Young white Americans are more suicide-prone than African Americans or Hispanic Americans at this age

Suicide rates are growing closer

The highest suicide rates of all is displayed by American Indians

The Elderly

In Western society the elderly are more likely to commit suicide than people in any other age group

There are many contributory factors:

Illness

Loss of close friends and relatives

Loss of control over one’s life

Loss of social status

Elderly persons are typically more determined than younger persons in their decision to die, so their success rate is much higher

The suicide rate among the elderly is lower in some minority groups in the U.S., especially American Indians and African Americans

Treatment and Suicide

Treatment of suicidal persons falls into two categories:

Treatment after suicide has been attempted

Suicide prevention

After a suicide attempt, most victims need medical care

Psychotherapy or drug therapy may begin once a person is medically stable

Unfortunately, even after trying to kill themselves, many suicidal people fail to receive systematic follow-up care

Therapy goals:

Keep the patient alive

Reduce psychological pain

Help them achieve a nonsuicidal state of mind and a sense of hope

Guide them to develop better ways of handling stress

Various therapies have been employed

Research indicates that cognitive-behavioral therapy may be particularly helpful

Prevention:

Hot lines are predominantly staffed by paraprofessionals – people trained in counseling but without formal degrees

There are also hundreds of suicide hot lines
(24-hour-a-day telephone services)

There are hundreds of suicide prevention programs in the U.S.

During the past 50 years, emphasis worldwide has shifted from suicide treatment to suicide prevention